In vitro evaluation of antimicrobial effect of miswak against common oral pathogens.

BACKGROUND AND OBJECTIVE: Miswak is a natural tooth cleaning tool which is being used in many parts of the world since ancient times. It is known to be useful in prevention of dental caries. But still it is not used as frequently as other oral hygiene tools. This research was designed to scientifically establish antimicrobial effect of miswak in vitro against common oral pathogens. METHODS: This was a cross-sectional study involving 100 health care workers. This research was carried out in Microbiology section of Dow Diagnostic Research & Reference Laboratory. A questionnaire was designed to test oral hygiene habits of study subjects. Oral swabs were taken and microorganisms were identified by standard bacteriological methods. Test material included four different types of miswaks i.e. (1) root of the peelu (Salvadora persica) tree (in packing) (2) root of the peelu tree (without packing) (3) stem of the peelu tree & (4) stem of the neem (Azadirechta indica) tree. These miswaks were tested against three different types of microorganisms isolated from oral swabs: Staphylococcus aureus, Streptococcus mutans & Candida albicans by agar diffusion method. Inhibition zone was measured after 24 hrs of incubation at 37(o)C. RESULTS: Among the miswaks used, root of the peelu tree in both packing and without packing exhibited strong antimicrobial effect against all three tested microorganisms. However miswak taken from the stem of the peelu and neem tree did not show any antimicrobial activity against all three types of the tested microorganisms. CONCLUSION: Miswak taken from the root of the peelu tree exhibited antimicrobial activity against all the common oral pathogens and could be a good oral hygiene tool in combating dental caries.

Efficacy of newly formulated ointment containing 20% active antimicrobial honey in treatment of burn wound infections.

BACKGROUND: Honey has been familiar to possess antimicrobial potential to clear infection against burn wound infecting bacteria since ancient times. The objective of the study was to evaluate the efficacy of the newly formulated honey ointment during the treatment of burn wound infections. The Experimental (Non comparative) study was conducted at outpatient department of Dermatology, Fauji Foundation Hospital, Rawalpindi from November 2009 to October 2010. METHODS: The antimicrobial activity of different Pakistani floral sources (Acacia nilotica species indica, Zizyphus, Helianthus annuus and Carisa opaca) honey samples were investigated by disc diffusion method against freshly isolated burn wounds infecting bacteria. Ointment containing 20% active antimicrobial honey was formulated as a sovereign remedy. A total number of twenty patients with second degree of burn wounds on different parts of the body were studied. A thin layer of honey ointment on gauze was applied to the wounds two to three times a day up to the complete healing. RESULTS: During microbiological study, Pakistani honey samples were discovered to exhibit a very promising antimicrobial activity against all the wound infecting microorganisms tested. Clinical trials demonstrated that the topical application of honey ointment have significant control of infections arising form pathogenic bacteria and up to 100% healing results were observed in all burn wound cases within mean healing time for the duration of 8.15 (3-18) days time period. CONCLUSION: Newly formulated ointment containing 20% active antimicrobial honey is more effective and low-cost alternative preparation for the treatment of burn wound infections.

A wide spectrum of dengue IgM and PCR positivity post-onset of illness found in a large dengue 3 outbreak in Pakistan.

During a large outbreak of dengue serotype 3 in Pakistan in 2006, multiple serum samples were routinely collected for laboratory testing. Two hundred ninety-seven samples were collected between August and November 2006. Serological testing for dengue IgM was performed in Pakistan and polymerase chain reaction (PCR) testing for dengue RNA detection and serotyping were performed in Hong Kong. Dengue-specific IgM was detectable as early as 1 day, and dengue RNA remained detectable for up to 14 days, post-onset of illness. Further statistical analysis found that IgM status (positive, negative, or equivocal) was significantly correlated to clinical (duration of illness, severity of patient-reported arthralgia pain, the presence of any evidence of bleeding, a positive tourniquet test, shock), and other laboratory (platelet and total white cell counts) parameters. In contrast, the qualitative dengue RNA status (PCR positive or negative) was not statistically significantly correlated with any of these other parameters. The results for this population during this outbreak, obtained from single acute samples, demonstrate a wide range of intervals post-onset of illness during which dengue IgM and dengue RNA may be detected. Interestingly, in this study, the dengue IgM positivity correlates more closely with significant clinical illness than the dengue RNA positivity, which may be a feature specific to this particular outbreak.

Pharmacokinetic study of cephradine in Pakistani healthy male volunteers.

To observe and discuss the difference in the pharmacokinetics of cephradine in Pakistani population with the reported data of other ethnic origins. A Single group pharmacokinetic study was conducted having six healthy male volunteers of 20-24 years of age. Blood samples were collected at appropriate times up to 7 hours. Plasma concentrations of cephradine was determined by HPLC technique and pharmacokinetic parameters were determined by both compartmental and noncompartmental methods using Kinetica ver 4.4.1 and Winnonlin ver 5.01. Peak plasma concentration was 11.49+/-1.73 microg/ ml achieved at 0.76+/-0.12 hr, after the administration of 250 mg cephradine to fasting volunteers. Area under the serum concentration-time curve was found to be 16.4+/-1.71 g.hr/ ml. Absorption, distribution, disposition and elimination half lives were calculated as 0.183 +/- 0.038 hr, 0.248 +/- 0.143 hr, 2.126 +/- 0.341 hr and 0.441+/-0.193 hr respectively where as the volume of central compartment and total body clearance were found to be 9.65+/-3.78 L and 15.4+/-1.89 L/hr. The plasma concentration time curves showed the absorption rate constant was 3.968 +/- 0.05 hr(-1), disposition rate constant was 0.333+/-0.05 hr(-1), distribution rate constant was 3.64+/-2.18 hr(-1) and elimination rate constant was 1.738+/-0.468 hr(-1). The value of micro-constants i.e. K(12) (central to peripheral compartment) and K(21) (peripheral to central compartment) were found to be 1.529+/- 1.499 hr(-1) and 0.704 +/- 0.44 hr(-1) respectively, where as MRT and AUMC were calculated as 2.04+/-0.09 hr and 35.92+/-1.86 hr(2) microg/ ml. The findings showed that the results of Pakistani subjects are slightly different when compared with the reported data of other ethnic origin.

Paediatric nosocomial infections: resistance pattern of clinical isolates.

Hospital acquired infections are transmitted to patients by hospital personnel and other patients, or they may arise from patient's own endogenous flora. Children are one of the most susceptible subjects associated in the hospital-acquired infections and have a higher prevalence rate for infections. This problem is at its extremes in developing countries like Pakistan where in most of cases the severity depends on the hygienic conditions of the Hospitals and lack or lapse of infection control measures. To have a surveillance type of data in this regard, one hundred and twenty four isolates of Pseudomonas aeruginosa/Pseudomonas species, Staphylococcus aureus (MRSA/MSSA) and Klebsiella species, that are commonest among the nosocomial infection causing organisms, were collected from pediatric hospital settings in Karachi. A study of incidence and resistance pattern by Kirby Baur disc diffusion method, with selected antimicrobials, was carried out. These isolates were resistant against most antimicrobials tested. Drugs like mmipenem, meropenem, amikacin, vancomycin (especially in MRSA or BRSA), Fucidic acid (for burns and other infections) and some of the 3rd generation cephalosporins were found quite effective.

Antimicrobial activity of Penicillins in common paediatric infections.

Pediatric bacterial infections are very rapidly growing in developing countries. Bacterial resistance to antimicrobial agents is a serious problem in the treatment of Pediatric bacterial infection. One of the most effective ways to control antibiotic resistance, is the development of surveillance programs. For this purpose isolates were collected from paediatric wards of different hospitals. The result shows that isolates were highly resistant against majority of selected antibiotics with increase in the MIC's. In Penicillin group, the most effective agent is Amoxicillin and Clavulanic acid, more than 90% isolates of Staphylococcus aureus were susceptible while other agents, as Cloxacillin, Ampicillin and Amoxicillin alone shows moderate activity against Staphylococcus aureus and Escherichia coli.

Comparative antimicrobial evaluation of Cephalosporins and Quinolones in common paediatric infections.

More than 90% of world's children are born each year in the developing world. Each year 12.9 million children die. Twenty eight percent of death are caused by pneumonia, 23% by diarrheal disease and 16% by vaccine-preventable diseases. Thirty-five thousand die each day, most from common and preventable problems. Health and illness are the result of a complex dynamic of environmental, social, political and economic factors. Bacterial resistance to antimicrobial agents is a continuing serious problem in the treatment of infections. Although this problem was recognized shortly after the commercial introduction of antimicrobial agents, it means that resistance is now emerging at a more rapid rate than ever before. To start with, during the present study an effort has been made to accomplish this task, 84 clinical isolates of Staphylococcus aureus, Escherichia coli and Pseudomonas aeruginosa were collected from different hospitals in Karachi. An in vitro study of these isolates was carried out by Agar dilution method using eleven antimicrobial agents and their combination (Lorian, 1991). Among Cephalosporins, third generation Cephalosporin, Cefotaxime was highly effective against Gram positive and Gram negative bacteria. Cefotaxime was active against Staphylococcus aureus, Escherichia coli and Pseudomonas aeruginosa. 1.19% isolates of Staphylococcus aureus, 19% isolates of Escherichia coli and 10% isolates of Pseudomonas aeruginosa were resistant against Cefotaxime. In Quinolone group, Ofloxacin was highly active against Staphylococcus aureus, Escherichia coli and Pseudomonas aeruginosa. Whereas 28% isolates of Staphylococcus aureus, 26% isolates of Escherichia coli and 11% isolates of Pseudomonas aeruginosa were resistant to Ofloxacin. Twenty six percent isolates of Staphylococcus aureus and 58% isolates Escherichia coli were resistant against Ciprofloxacin.

Resistance pattern of different aminoglycosides against Gram positive and Gram negative clinical isolates of Karachi.

Microbial resistance to majority of the available antimicrobial agent is a serious and global problem. Due to heavy and discriminate usage of antibiotics, high prevalence of drug-resistant bacteria in the indigenous fecal flora, poor standards of sanitation, lack of education and prevalence of malnutrition. This problem is at its extreme in developing countries like Pakistan. For this various Aminoglycosides were tested against different Gram positive and Gram negative isolates. The results showed that these isolates were resistant against most of these antibiotics with increase in MIC's. In Aminoglycoside group Tobramycin was the most effective agent against Staph. aureus and E. coli with MIC90s of 1 microg/ml and 2 microg/ml, while against Klebsiella and P. aeruginosa its activity was moderate to low. Amikacin showed highest activity against P. aeruginosa, E. coli and Klebsiella species with MIC90s of 4 microg/ml and 8 microg/ml. Kanamycin and Streptomycin were not active against the tested isolates.